| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,605 |
1,348 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,661 |
1,377 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,507 |
1,253 |
$35K |
| D1351 |
Sealant - per tooth |
469 |
283 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
537 |
389 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
512 |
442 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,401 |
1,134 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
481 |
382 |
$7K |
| D0274 |
Bitewings - four radiographic images |
405 |
342 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
255 |
187 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
120 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,088 |
890 |
$4K |
| D0272 |
Bitewings - two radiographic images |
478 |
395 |
$4K |
| D1110 |
Prophylaxis - adult |
132 |
121 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
60 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
89 |
$2K |